Supplemental Report Form /
Facility Name ______
/

Permit Number ______

Month ______, 20______
DATE / DAY OF WEEK / PRECIPITATION
(INCHES) / INFLUENT FLOW
(MGD) / EFFLUENT FLOW
(MGD) / INFLUENT CBOD5
(mg/L) / EFFLUENT CBOD5
(mg/L) / PERCENT REMOVAL
CBOD5 / EFFLUENT CBOD5
(kg/day) / INFLUENT TSS
(mg/L) / EFFLUENT TSS
(mg/L) / PERCENT REMOVAL TSS / EFFLUENT TSS
(kg/day) / INFLUENT pH / EFFLUENT pH / INFLUENT PHOSPHORUS (mg/L) / EFFLUENT PHOSPHORUS (mg/L) / EFFLUENT
PHOSPHORUS
(kg/day) / EFFLUENT AMMONIA
(mg/L) / EFFLUENT D.O. (mg/L) /
FECAL COLIFORM
(number/100 ml) / EFFLUENT CHLORINE RESIDUAL (mg/L)
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13 / 14 / 15 / 16 / 17 / 18 / 19 / 20 / 21
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total

wq-wwtp-7-03 This form should be submitted with your Discharge Monitoring Report (DMR) forms. 4/04

/ Minnesota Pollution Control Agency /

SUPPLEMENTAL DATA and COMMENTS

Comments--Include information on violations, bypasses/overflows, maintenance conducted, etc. (Attach additional pages if necessary.)
Weekly Observations for Stabilization, Aerated, Polishing or Absorption Ponds
TYPE OF POND (AERATED, PRIMARY, ETC.) / ______POND ______ACRES / ______POND ______ACRES / ______POND ______ACRES
WEEK OF THE MONTH / 1ST / 2ND / 3RD / 4TH / 5TH / 1ST / 2ND / 3RD / 4TH / 5TH / 1ST / 2ND / 3RD / 4TH / 5TH
1. DATE OF OBSERVATION
2. ODOR (YES OR NO)
3. AQUATIC PLANTS (% OF COVERAGE, TYPE)
4. FLOATING MATS (% OF COVERAGE, TYPE)
5. WATER DEPTH (UNITS______)
6. MUSKRATS, RODENTS, ETC. (YES OR NO)
7. DIKE CONDITION (EROSION, ETC.)
8. ICE COVER (% OF COVERAGE)
Send with DMRs to:
Minnesota Pollution Control Agency
520 Lafayette Road North
Saint Paul, Minnesota 55155-4194
Attention: Discharge Monitoring Reports
wq-wwtp-7-03 / ______
Signature of Authorized Agent / ______
Signature and Phone Number of Certified Operator
4/04

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